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What is a hindfoot fusion?
Most hindfoot arthritis can be treated without surgery. A hindfoot fusion is an operation considered for severe hindfoot arthritis, once non-operative treatments have been exhausted and if your symptoms remain significant. It is a well-established surgical treatment and has been proven to be effective. The goals are to permanently stiffen one or more of your hindfoot joints that have arthritis and the lack of movement alleviates pain. If all three of your hindfoot joints require fusing it is called a triple fusion.
What happens during a hindfoot fusion?
In most cases the operation is performed under general anaesthetic (whilst you are asleep). Alternatively, you can have a spinal or regional anaesthetic, which just numbs the leg.
Surgical cuts are made on top and / or on the side of your foot. The operation involves removing the damaged cartilage of the joint surfaces from each arthritic joint. Then the bones are placed in the correct position and are rigidly held together using screws, plates or staples. This allows natural bone healing, to fuse your affected joints. Occasionally some extra bone is required to help with the healing, either your own bone or from donor bone.
Once the operation is completed, the wounds are closed with stitches, local anaesthetic is given to provide pain relief for the first few hours after surgery and you will be placed in a temporary plaster cast.
What are the risks of a hindfoot fusion?
The risks of any operation generally relate to the anaesthetic and the surgical procedure.
You will be able to discuss your anaesthetic options and associated risks with the anaesthetist before your surgery. With a general anaesthetic, the risks will vary depending on your general health.
The main surgical risks of a hindfoot fusion are listed below, but it is not exhaustive. These will be further explained in the outpatient clinic.
Blood clots (leg or lung) – There is small risk of developing a blood clot after major surgery. You will be individually assessed and may be given blood thinning medication to reduce the risk of developing a blood clot.
Failure of fusion – There is a 10% risk your joints will not fuse together and may need to be rectified with a second operation. Patients who smoke are at a much higher risk of this complication. We will therefore ask you to stop smoking (including nicotine vapes) before surgery and while your hindfoot joints are fusing together. We can direct you to services that can help with smoking cessation.
Infection – The risk of infection with any foot and ankle operation is up to 5%. The majority are minor infections that can be simply treated with antibiotics. Occasionally, some patients can develop a deeper infection that might require another operation.
Nerve injury – With an operation, there is always a small risk of injuring or stretching the surrounding nerves, which can lead to numbness or even weakness. These symptoms mostly resolve in time, but they can persist.
Progression of arthritis – By fusing your arthritic hindfoot joints, this places increased stress on other joints in your foot and ankle, and they can subsequently develop arthritis. This may require further treatment.
Swelling– The foot and ankle will swell after surgery in response to the surgery and the healing process. It will take more than 12 months for the swelling to settle and some may persist.
Mal-position – When the hindfoot is fused it may not be in the correct position. If the position is problematic some patients may consider further surgery to adjust this. Great care is taken during surgery to avoid this complication.
Prominent metalwork – If the metalwork becomes a problem, you can have another operation to remove it. After nine months your fusion will be solid so the metalwork can be removed if required.
Chronic regional pain syndrome – Following foot and ankle surgery a very small proportion of patients can develop chronic regional pain syndrome. Your foot becomes indefinitely painful, swollen and sensitive. If you develop this, you may require specialist care from a pain consultant.
What happens after my operation?
When will I go home after surgery?
After surgery, most patients can go home the following day. You may require additional time in hospital, if you have other significant medical problems or general poor mobility.
Will I be able to walk on it after surgery?
For the first six weeks after surgery you are advised not to put any weight through your operated leg. Before you go home the physiotherapist will make sure you are safe to get around on crutches. Some patients though find crutches difficult. A knee scooter can be easier to use and information can be provided on this. Also, in the first few weeks keep your leg elevated as much as possible to help reduce the swelling and aid wound healing. It is important that your cast remains dry and you may find using a waterproof cover helpful (www.limboproducts.com).
When will I be seen after surgery?
You will be seen two weeks after surgery in the outpatient clinic. Your wounds will be checked, your stitches removed and a lightweight fibreglass cast will be applied.
You will then be seen six weeks after surgery with an X-ray. If everything is progressing well, you will be provided either with a removable cast or a surgical boot and you can slowly put weight through your operated leg as your comfort levels allow.
You will be seen again 12 weeks after surgery with another X-ray. If your hindfoot is fusing together you can go into your own supportive shoes (preferably with an orthosis). You will be referred to our specialist physiotherapists for strengthening exercises and help with your walking pattern (gait). Further appointments will depend on your individual progress.
When can I go back to work?
If you have a sedentary job (desk based) and can elevate your foot, you can return to work six weeks after surgery. If you have a more physically strenuous job, you may need significantly longer off work. Generally, after a hindfoot fusion it takes up to 12 months to gain the full benefit.
When can I drive?
You can start driving when you are comfortably walking in your own footwear. If you cannot safely make an emergency stop, your insurance will not cover you in the event of an accident. Start by sitting in the car and trying the pedals, then drive round the block. Drive short distances before long ones. If you are having surgery on your left leg and drive an automatic car, you could consider driving sooner, but only if you are safe to do so.
How quickly can I return to activities?
After a hindfoot fusion it varies how quickly people can return back to some activities. When comfortable in your own shoes gradually build up your walking distances. Playing golf is possible but it is rare to participate in running sports. You will be guided by our physiotherapists during the rehabilitation program.
When can I fly after surgery?
If you are flying after recent surgery you are at an increased risk of developing a blood clot in one of the deep veins in your body, usually the leg (deep vein thrombosis or DVT). Please ask your surgeon for individual guidance on how long to delay flying after your surgery. Also, each airline has its own regulations about flying after surgery and you will need to check with your airline before flying.
Patients that have a healthy diet, take regular exercise and refrain from smoking are more likely to experience a quicker recovery with a more successful outcome from their surgery.
Taking vitamin C supplements for six weeks before surgery and six weeks after surgery can also be beneficial. You can purchase them from your local pharmacy or supermarket.
If you have any concerns about your general health and well-being (diet, exercise, smoking cessation) you are encouraged to discuss this with your GP, who will be able to provide advice on the options available to you.
We hope this leaflet has answered any questions you might have. If you have any further queries, please feel free to discuss them with any of the medical or nursing staff.